• Tetsuro Takegami, Keisuke Imai, Kunihiko Umezawa, Satoshi Kimura, Shogo Ogita, Masashi Hamanaka, and Eito Ikeda.
• Department of Emergency, Acute Stroke Care Center, Kyoto First Red Cross Hospital, 15-749 Honmachi, Higashiyama-ku, Kyoto-city, Kyoto 605-0981, Japan.
• No Shinkei Geka. 2012 Aug 1; 40 (8): 705-9.

AbstractWe report a rare case of a young man who had spontaneous left vertebrovertebral fistula associated with neurofibromatosis Type 1. His complaints were severe pain in the left neck and numbness in the left upper extremity. Cervical MR images showed a large abnormal flow void to the left of the spinal canal. An angiogram demonstrated a fusiform aneurysm and a high flow arteriovenous fistula in the left vertebral artery that drained into the internal vertebral plexus and formed a large venous varix. The occipital artery, the thyrocervical artery and the contralateral vertebral artery were associated with the fistula. The arteriovenous fistula was treated by endovascular coil embolization, using a tandem balloon technique. For this fistula, exhibiting the combination of high flow and multiple associated arteries, the flow control technique during the coil embolization, using tandem balloons in both the subclavian artery and the distal portion of the fistula of the vertebral artery, was safe and feasible for preventing coil migration.

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